| William R Grubb Md Inc | |
|
1705 E 19th St 400 Tulsa OK 74104-5405 | |
| (918) 742-7331 | |
| (918) 742-7332 |
| Full Name | William R Grubb Md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1705 E 19th St, Tulsa, Oklahoma |
| Authorized Official Name and Position | William R Grubb (OWNER) |
| Authorized Official Contact | 9187567110 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| William R Grubb Md Inc 1705 E 19th St 400 Tulsa OK 74104-5405 Ph: (918) 742-7331 | William R Grubb Md Inc 1705 E 19th St 400 Tulsa OK 74104-5405 Ph: (918) 742-7331 |
| NPI Number | 1447551122 |
|---|---|
| Provider Enumeration Date | 11/11/2010 |
| Last Update Date | 05/14/2013 |
| Medicare PECOS PAC ID | 2567691371 |
|---|---|
| Medicare Enrollment ID | O20140127000878 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447551122 | NPI | - | NPPES |
| 100100630A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 10720 (Oklahoma) | Primary |
| Provider Name | William R Grubb |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164582375 PECOS PAC ID: 1658566518 Enrollment ID: I20101117000824 |
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